Gender Disparities Persist in Treatment of Stroke

TUESDAY Feb. 10, 2009 -- Significant gender differences continue to persist with stroke, not only in its incidence, but also in its prevention and treatment.

Among other things, women with stroke are more likely to experience emergency room delays and less likely to be treated aggressively for risk factors beforehand, according to a raft of studies coming out in a specially themed April issue of Stroke. The findings were released this week to coincide with Go Red for Women Day.

"I find it shocking that we are constantly speaking to women about empowering themselves, and then we look at the other side, and these doctors aren't delivering the care that these women need," said Dr. Suzanne Steinbaum, director of Women & Heart Disease at Lenox Hill Hospital in New York City. "We know that women who have atrial fibrillation need to be on blood thinners. Only 64 percent of women in atrial fibrillation were on blood thinners to prevent stroke. Across the board, this is the standard of care."

"There's a treatment gap and an awareness gap," said Dr. Lori Mosca, spokeswoman for the American Heart Association's Go Red for Women director of preventive cardiology at New York Presbyterian Hospital in New York City. "Women are more disabled by stroke, the consequences of stroke in women are greater than they are in men. The data really parallel what we see in heart disease. Women are less likely to get treated with therapies that have been proven to really benefit them."

Stroke is the third leading killer among women. And it's expected that the incidence and hence, the burden, of stroke among women will only increase with time and the aging of the population.

By 2050, according to projections, death from stroke among women will exceed that in men by 30 percent.

One group of researchers reporting in this issue of the journal found that women with ischemic stroke (when an artery to the brain is clogged) were 14 percent less likely to receive what the authors called "perfect" or "defect-free" care.

Overall, the absolute differences between genders were small, but more troubling and clinically relevant gaps existed in how many women were treated with tPA (clot-busting drug) and in how well they were treated for high cholesterol.

Women were also 16 percent less likely to be sent home after a stroke, meaning they were more likely to be institutionalized, than men.

Here's a run-down of the other findings:

There were significant differences between genders on 47 of 126 "elements" studied. The analysis of the Colorado Stroke Registry found that women were older and fared worse after a stroke than men. Risk factors also differed, with men more likely to have coronary artery disease, high cholesterol, diabetes, narrowing of the blood vessels and to be smokers, while women were more likely to have atrial fibrillation and hypertension as contributing factors. Women tended not to be treated as aggressively as men.

A new analysis of data from The Framingham Heart Study found that women tended to be older than men (75.1 vs. 71.1) at the time of their first stroke; had more strokes after the age of 85 than men, although fewer in other age brackets and a higher incidence overall. Women tended to have more trouble dressing, grooming and moving from a bed to a chair both before, during and after a stroke. They were more than three times as likely as men to end up in an institution after a stroke.

Women with acute stroke were delayed longer in emergency rooms and were less likely to experience some of the warning signs of a stroke. "We've done a good job teaching people about symptoms of a heart attack. We need to have a similar message for stroke," Mosca said. "A lot of people don't realize if you have numbness or loss of function in your face, arms, legs, one side of your body or you have a sudden headache, these things can actually indicate a stroke, so it's hugely important for you to call 911. The warning signs are not on the radar screen as they are for heart attack."

Women showed a troubling lack of knowledge when it came to identifying risk factors for stroke or knowing what behaviors might actually prevent such an eventuality. The women in the study, who were mostly white, also tended to underestimate their risk.

Finally, other researchers advocated a national registry to help determine which preventive drug would be most effective in pregnant women with a history of stroke.

"Guidelines for the treatment of stroke, prevention of stroke, management of stroke need to be aggressively enforced for women patients, because now we're getting statistics that women patients are actually going to be having more strokes than men," Steinbaum stressed.

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